Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained from client/author/4962.
Veterinary acupuncture is growing in popularity among pet owners for a multitude of conditions, both chronic and acute, experienced by companion animals2.
A 13-year-old Anatolian Shepherd presented for difficulty ambulating, decreased response to oral NSAIDs, and progressive muscle atrophy and hind end weakness. The patient was treated with NSAIDs, tramadol, gabapentin, trazodone, Adequan injections, and cold laser therapy starting in May 2016. He presented for consultation for acupuncture therapy in early November 2016 after his owners felt he was deteriorating. Dry needling was added to his treatment protocol alongside weekly laser therapy. The patient’s owners appreciated a noticeable improvement in his activity level, decreased restlessness, and overall comfort after his second treatment.
Scooter, a 13-year-old, 96 pound, castrated male Anatolian Shepherd has a long history of orthopedic concerns beginning in 2006, when he was three years old and diagnosed radiographically with bilateral hip dysplasia. In 2008, Scooter underwent surgical repair of both cranial cruciate ligaments. He sustained a septic left stifle joint in 2010 which was managed at the local surgical center. In 2015, Scooter suffered from osteoarthritis in both stifles. Scooter had no other major illness or injuries prior to arthritis pain in 2015. He was started on Rimadyl 100mg twice daily, Adequan injections (2mL intramuscularly), and tramadol 100 mg twice-three times daily as needed. His medical record noted continued slow muscle mass loss starting in 2015 and in May 2016 weekly cold laser therapy was initiated and continued through present. His owners reported Scooter seeming restless or mildly disoriented during the last few months before presenting for acupuncture and he was prescribed trazodone 100mg as needed. In November 2016, Scooter presented for difficulty rising and his owners felt his quality of life was poor and wanted to discuss options. He was evaluated for possible acupuncture therapy which was initiated mid-November 2016.
PHYSICAL EXAM AND CLINICAL ASSESSMENT
Physical examination revealed marked atrophy of the epaxial muscles in the lumbar region, symmetrical atrophy of the hindquarters, markedly decreased range of motion in hips, stifles, shoulders, and elbows. The patient’s right elbow was moderately callused and inflamed, with the surrounding hair damp and stained with saliva. Moderate muscle atrophy of the temporalis muscles, supra- and infrascapularis muscles, and triceps muscles noted. Marked myofascial restriction was palpated over his dorsolateral thorax and taut muscle bands palpated along his dorsal neck and shoulders bilaterally. He was able to rise from sitting or laying down with support, and was ambulatory with intermittent knuckling of both hind paws. He appeared post-legged in his hind end, with severe muscle atrophy of his quadriceps bilaterally and crepitus noted in both stifles as he shifted his weight while laying down. Scooter displayed signs of agitation and anxiety during his first two sessions: yawning, whining, panting heavily, pacing the exam room, and being reluctant to relax on a padded mat. Further examination revealed flea infestation; he was treated with Capstar (nitenpyram) in clinic and Nexgard (afoxolaner) to go home. He relaxed on the mat within 5-10 minutes at his next session.
MEDICAL DECISION MAKING
Scooter had responded well to laser therapy and oral medication +/- Adequan injections initially. His lab work however indicated possible liver compromise over several months and Scooter experienced diarrhea intermittently, after frequent medication dosing. He began to deteriorate and his owners were willing to try acupuncture therapy as they felt they were running out of options and Scooter could not tolerate more medication. Scooter has significant osteoarthritis in his stifles and hips, and relied heavily on his front legs to help him ambulate, therefor acupuncture target points were determined to be his hips, stifles, lumbar spine, and shoulders. Scooter becomes anxious in the clinic, panting, whining, and glancing around, yawning occasionally. Initially, therapy was broken down into shorter sessions as Scooter tolerated it. The goal was set to help relieve his hind-end discomfort with dry needling and laser1. Acupuncture points for relaxation and followed by hip and stifle pain were focused upon. I tried to work with what Scooter presented to me for his exams and treatment to keep the sessions short and enjoyable for him. Laser therapy was added later during acupuncture to increase the effects of acupuncture while Scooter tolerated it.
Scooter has undergone seven acupuncture treatments to date. Treatments 1-4 were once weekly; a 10-day break occurred between his 4th and 5th treatment, and then he resumed weekly treatments once again. He continues to present weekly for laser and acupuncture while his owners and I feel he is benefitting. The points utilized vary slightly each week and include: stomach (ST) 34 and 36 for stifle pain, spleen (SP) 10 for stifle pain; small intestine (SI) 11, 12, for shoulder pain and occasionally 9; bladder (BL) 54 for hip pain, 10 for tension and tender points, 20, 21, for digestive upset and diarrhea, and 15 for anxiety; gallbladder (GB) 29 for hip pain; governor vessel (GV) 20 and 14 for anxiety; and Bai Hui for lumbosacral discomfort, pelvic limb pain and neurological problems.
All points chosen were dry needled, and from the third session on, laser therapy was added to the points needled on the hind limbs: GB 29, SP 10, ST 34 and 36, and BL 54.
OUTCOMES, DISCUSSIONS, REFERENCES
Scooter has responded favorably to acupuncture therapy since treatment initiated. He is reported to be less anxious at home for 4-5 days after treatment and the day following treatment he is able to get up on his own with minimal assistance (verbal encouragement and a hand under his abdomen). During the 10 days without acupuncture, owners reported Scooter was reluctant to rise and spent several hours in one carpeted area of the home every day. In clinic, Scooter is noted to knuckle and scrape his nails on his hind paws on the day he presents for acupuncture. He continues to knuckle occasionally immediately after treatment, but his proprioceptive deficits are milder. I would like to add electroacupuncture therapy to his treatment plan going forward. He appears to tolerate dry needling for 20-30 minutes at a time now rather than less than ten minutes initially. Acupuncture is an excellent non-pharmaceutical, non-invasive therapeutic option for patients that may not be good surgical candidates, or may be unable to take certain analgesic medications due to concurrent liver or kidney compromise.
- Downing, Robin, CVPP CCRP Dipl AAPM. “Options for Treating Pet Pain Continue to Expand.” Veterinary Practice News, 21 May 2013. Web. 8 Jan. 2017.
Habacher, Gabriele, Max H. Pittler, and Edzard Ernst. “Effectiveness of Acupuncture in Veterinary Medicine: Systematic Review.” Journal of Veterinary Internal Medicine 20 (2006): 480-88. Web. 8 Jan. 2017